Dr. Mark Bertin, M.D., a board certified developmental behavioral pediatrician, studied at the UCLA School of Medicine and completed his training in general pediatrics at Oakland Children's Hospital in California. Dr. Bertin is an Assistant Professor of Pediatrics at New York Medical College. Dr. Bertin is a frequent lecturer for parents, teachers and professionals on topics related to child development including autistic spectrum disorders, ADHD and parenting. Dr. Bertin is the author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child's Attention While Minimizing Parents' Stress. His "Child Development Central" blog can be found on the websites of Psychology Today, The Huffington Post and Education Update. His website is www.developmentaldoctor.com.
In your book, The Family ADHD Solution, you mention that if a child has been diagnosed with ADHD, there's a good chance that at least one of parents may have ADHD as well. What parenting issues are more common in a family where both the parent and the child have ADHD?
Parents of a child with ADHD have a two-to three-fold increased chance of having it themselves. Since ADHD typically affects organization, planning and life management in general, it can influence how people parent. Managing ADHD requires consistency and an emphasis on routine, which can be difficult when parents have untreated ADHD themselves. Even maintaining an emphasis on positive feedback and reward can be harder with ADHD, because of reactivity, distractibility and other symptoms.
Why is an emphasis on praise and reward particularly important for children with ADHD?
Most children are motivated by positive feedback of any kind from grown-ups, and targeted praise and reward can help improve behavior all on their own. It's not only that, though. Without using praise and reward, we're left with nothing but correction and punishment for changing behavior.
Children with ADHD get an incredible amount of negative feedback from parents and teachers. And they often do need some kind of redirection to stay safe or just get their schoolwork done. To maintain a sense of balance in their lives, children with ADHD need an ongoing focus on praise and success, regardless of what's going on in the bigger picture. Empty praise isn't useful, so it can take effort. Adults may need to go out of their way to find even small successes. Praise and reward may not change everything on their own, but are still the first step in any behavior plan.
How would you answer criticisms that giving a child a reward for good behavior is just the same as bribing them?
All of us are more motivated to do things we enjoy or that give us sense of worth. With ADHD, though, when something isn't completely exciting, it is physically difficult to stay on task for neurological reasons. Using rewards to increase motivation is a nudge in the right direction, a way to keep the brain on target.
In Chapter 9 of The Family ADHD Solution, "Medical Options for ADHD," you write that "it is inherently unfair to expect someone with a neurologically-based disorder to overcome it through effort and willpower alone" (p. 178). Could you explain in what ways medication can help children with ADHD?
People suggest all sorts of causes, but in the end the research is clear: ADHD is a medical condition. The parts of the brain responsible for self-regulation as a whole aren't active enough; it's not only about inattention or impulsiveness. When used well, medications stimulate this underactive region to work more efficiently. The research regarding potential benefits is clear. They have a far greater impact on ADHD symptoms than anything else studied so far.
Medications don't fix everything on their own, but they allow someone to regulate their behavior who otherwise can't.
What are three things parents can do right now to help improve day-to-day living for their children with ADHD?
The first step is to understand ADHD as a deficit of executive function, which is a much broader group of skills than focus or controlling activity level. It's like a child has an overall developmental delay in self-regulation. Seeing it that way allows parents and teachers to address what's really going on. Children with ADHD aren't trying to be difficult or lazy, they just don't have the skills to do what's being asked of them yet.
A next step is exploring all possible treatment options. We want children to catch up in their development as quickly as possible. ADHD affects all aspects of life, not only education, so children benefit from interventions at home and school. When talking about medication or alternative medicine, it's important to seek out objective information, balancing potential risks and benefits. For most children, some combination is needed that considers medical and non-medical options, not just one quick fix.
Third, as a parent of a child with ADHD, taking care of care of your child means taking care of yourself, too. If you're completely overwhelmed, exhausted or shut down by stress, you're probably not going to be as understanding and effective a parent as you might be otherwise. While you're kids come first in the bigger picture, taking time to maintain your own strength and resilience helps your whole family in the long run.
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